Citation Nr: 0127084
Decision Date: 12/07/01 Archive Date: 12/11/01
DOCKET NO. 97-09 754 ) DATE
)
)
On certification from the
Department of Veterans Affairs Regional Office in St.
Petersburg, Florida
THE ISSUE
Entitlement to service connection for post-traumatic stress
disorder (PTSD).
REPRESENTATION
Veteran represented by: The American Legion
WITNESS AT HEARINGS ON APPEAL
Veteran
ATTORNEY FOR THE BOARD
L. J. Nottle, Counsel
INTRODUCTION
The veteran had active service in the United States Navy from
August 1965 to August 1967. Thereafter, he served in the
United States Naval Reserve. His claim comes before the
Board of Veterans' Appeals (Board) on appeal from an October
1996 rating decision of the Department of Veterans Affairs
(VA) Regional Office in Togus, Maine. While the appeal was
pending, the veteran moved and his claims file was
transferred to the VA Regional Office in St. Petersburg,
Florida (RO), where the veteran's appeal was certified for
review.
FINDINGS OF FACT
1. The RO has notified the veteran of the evidence needed to
substantiate his claim and has obtained and fully developed
all evidence necessary for the equitable disposition of that
claim.
2. There is medical evidence of record diagnosing PTSD.
3. The veteran did not engage in combat during his period of
active service.
4. There is credible supporting evidence of record that some
of the claimed stressors occurred.
5. Medical professionals have diagnosed the veteran with
PTSD based on verified stressors.
6. The veteran's PTSD is etiologically related to his period
of active service service.
CONCLUSION OF LAW
PTSD was incurred in service. 38 U.S.C.A. §§ 1110, 5107
(West 1991 & Supp. 2001); 38 C.F.R. §§ 3.102, 3.303, 3.304(f)
(2001), as amended by 66 Fed. Reg. 45,620-45,632 (Aug. 29,
2001) (to be codified as amended at 38 C.F.R. §§ 3.102,
3.156(a), 3.159, 3.326(a)).
REASONS AND BASES FOR FINDINGS AND CONCLUSION
As an initial matter, the Board notes that during a hearing
held at the RO in April 2001, the undersigned Board Member
indicated that he would hold the record open for 60 days so
that the veteran could submit additional evidence in support
of his appeal. In June 2001, the veteran submitted such
evidence with a written statement waiving initial RO
consideration of this evidence under 38 C.F.R. § 20.1304(c)
(2001). In light of the waiver, the Board may consider this
evidence in the first instance and need not remand it to the
RO for review.
The issue before the Board is whether the veteran is entitled
to service connection for PTSD. The RO denied the veteran
entitlement to this benefit in December 1995 and October
1996, and the veteran appealed the latter decision. While
his appeal was pending, legislation was passed that enhances
the VA's duties to notify a claimant regarding the evidence
needed to substantiate a claim and to assist a claimant in
the development of a claim. See the Veterans Claims
Assistance Act of 2000 (VCAA), Pub. L. No. 106-475, 114 Stat.
2096 (2000) (codified as amended at 38 U.S.C. §§ 5102, 5103,
5103A, 5107). The change in the law is applicable to all
claims filed on or after the date of enactment of the VCAA,
or filed before the date of enactment of the VCAA and which
are not final as of that date. 38 U.S.C.A. § 5107, note
(Effective and Applicability Provisions) (West Supp. 2001).
Further, during the pendency of this appeal, in August 2001,
the VA issued regulations to implement the VCAA. 66 Fed.
Reg. 45,620 (Aug. 29, 2001) (to be codified as amended at 38
C.F.R. §§ 3.102, 3.156(a), 3.159 and 3.326(a)). The
amendments were effective November 9, 2000, except for the
amendment to 38 C.F.R.
§ 3.156(b), which is effective August 29, 2001.
Where the law or regulations change after a claim has been
filed or reopened but before the administrative or judicial
appeal process is completed, the version of the law or
regulations most favorable to the appellant applies unless
Congress provides otherwise. Karnas v. Derwinski, 1 Vet.
App. 308, 313 (1990). In this case, the RO has not developed
the veteran's claim pursuant to the VCAA. However, as
explained below, prior to the enactment of the VCAA, the RO
took action that is consistent with the notification and
assistance provisions of the VCAA. In addition, the RO has
not considered the veteran's claim pursuant to the VCAA.
However, prior to the enactment of the VCAA, the RO denied
the veteran's claim on the merits, rather than on the basis
that is was not well grounded. That decision is thus
consistent with the VCAA, which eliminates the need for a
claimant to submit a well-grounded claim and requires an
adjudicator to proceed directly to an adjudication of the
merits of a service connection claim (provided the
adjudicator finds that the VA has fulfilled its duties to
assist and notify). In light of the foregoing, the Board's
decision to proceed in adjudicating this claim does not
prejudice the veteran in the disposition thereof. See
Bernard v. Brown, 4 Vet. App. 384, 392-94 (1993).
As required by the VCAA, the RO informed the veteran of the
evidence needed to substantiate his claim and provided him an
opportunity to submit such evidence. See 38 U.S.C.A. §§
5102, 5103 (West Supp. 2001). In February 1996 and May 1996,
after the veteran filed his initial claim for service
connection for PTSD, the RO sent the veteran letters clearly
explaining the evidence needed to process the veteran's
claim. In these letters, the RO either requested the veteran
to submit more detailed written statements of the in-service
stressors that allegedly caused his PTSD and additional
medical records and authorizations to obtain those records,
or notified the veteran that it was waiting to receive
pertinent medical records before deciding the veteran's
claim. After these letters were sent, the veteran complied
with the RO's requests for additional information and the RO
received the pertinent information to which it had referred.
In addition, in a rating decision dated October 1996 and a
November 1996 letter notifying the veteran of this decision,
the RO explained the reasons for which it had denied the
veteran's claim. Finally, in a statement of the case issued
in December 1996, and supplemental statements of the case
issued in February 1997 and February 1998, the RO again
explained the reasons for which it had denied the veteran's
claim, notified the veteran of all regulations pertinent to
his claim, and provided him other opportunities to submit
additional evidence and to present additional argument,
including in the form of hearing testimony, in support of his
claim. The veteran took advantage of these opportunities by
subsequently submitting written statements and medical
records and by presenting testimony at hearings held at the
RO before a hearing officer in October 1997 and before the
undersigned Board Member in April 2001.
As required by the VCAA, the RO also fulfilled its duty to
assist the veteran in obtaining and fully developing all of
the evidence relevant to his claim. See 38 U.S.C.A. § 5103A
(West Supp. 2001). For instance, the RO obtained and
associated with the claims file all evidence identified by
the veteran as being pertinent to his claim, including VA and
private inpatient and outpatient treatment records and a
letter from the Social Security Administration (SSA), which
reflects that the veteran was awarded disability benefits for
disorders of the back (primary diagnosis) and depression
(secondary diagnosis), not for PTSD. As well, for the
purpose of endeavoring to verify the veteran's claimed in-
service stressors, particularly, his alleged presence on the
flight deck of the USS Enterprise, the RO contacted the
National Personnel Records Center and obtained and associated
with the claims file the veteran's service personnel records.
Finally, as previously noted, during a hearing held at the RO
in April 2001, the undersigned Board Member indicated that he
would hold the record open for 60 days so that the veteran
could submit additional evidence in support of his appeal.
In June 2001, the veteran submitted such evidence.
In addition to obtaining all pertinent evidence, the RO
developed the medical record to the extent necessary to
decide the veteran's claim. For instance, in November 1995
and August 1996, the RO afforded the veteran VA PTSD
examinations, during which the same examiner discussed
whether the veteran had PTSD. In October 1997, after the
veteran questioned the competency of the examiner, the RO
afforded the veteran another VA PTSD examination, during
which a second examiner determined whether the veteran had
PTSD.
Inasmuch as the RO has notified the veteran of the evidence
needed to substantiate his claim and has obtained and fully
developed all relevant evidence necessary for the equitable
disposition of that claim, a Remand to comply with the VCAA
would serve no useful purpose. See Soyini v. Derwinski, 1
Vet. App. 540, 546 (1991) (holding that strict adherence to
legal requirements does not dictate an unquestioning, blind
adherence in the face of overwhelming evidence in support of
the result in a particular case because such adherence would
impose additional burdens on the VA with no benefit flowing
to the veteran).
The veteran seeks service connection for PTSD. The
regulation governing this type of claim, 38 C.F.R. § 3.304(f)
was amended while the veteran's appeal was pending, effective
March 7, 1997. As previously indicated, where the law or
regulations change while an appeal is pending, the version
most favorable to the claimant applies, absent congressional
intent to the contrary. Karnas, 1 Vet. App. at 312-313. In
this case, the RO did not notify the veteran of the change in
regulation or consider the veteran's PTSD claim under both
the former and revised regulations. However, because neither
version of the regulation is more favorable to the veteran,
the veteran has not been prejudiced as a result thereof.
Bernard, 4 Vet. App. at 392-94.
To establish entitlement to service connection for PTSD under
the former regulation, the veteran must submit medical
evidence establishing a clear diagnosis of the condition,
credible supporting evidence that the claimed in-service
stressor actually occurred, and a link, established by
medical evidence, between current symptomatology and the
claimed in-service stressor. 38 C.F.R. § 3.304 (1996).
Under the revised regulation, the veteran must submit medical
evidence diagnosing the condition in accordance with Sec.
4.125(a) of this chapter; a link, established by medical
evidence, between current symptoms and an in-service
stressor; and credible supporting evidence that the claimed
in-service stressor occurred. 38 C.F.R. § 3.304(f) (2001).
Both the former and revised regulations require a diagnosis
of PTSD, evidence which, as shown below, has been submitted
in this case.
The veteran served on active duty from August 1965 to August
1967, including on the USS Enterprise from September 1965 to
August 1967. He contends that he developed PTSD as a result
of stressors experienced during his sea service on the
aforementioned nuclear-powered aircraft carrier. These
stressors include: (1) being transferred from the Captain's
office, where he was serving as a yeoman striker, to the
flight deck, where, due to a shortage of workers, he was
expected to perform with no training; (2) being beaten up and
threatened by an aviation boat chief and knowing others who
were also beaten up by the same individual; (3) witnessing
[redacted], his flight deck buddy, disappear over the
side of the ship one day after initiation, crossing the
equator, in the fall of 1966, when they were on night
recovery, walking a tow-bar after an A-3 had landed, and the
force of jet exhaust blew Mr. [redacted] overboard; (4)
witnessing a jet pilot, whose name the veteran has forgotten,
get out of his plane, walk toward flight deck control and get
blown into the propellers of an aircraft; (5) being within
six feet of [redacted], who got sliced by a turnbuckle,
necessitating 14 hours of life-saving surgery; (6) witnessing
an A3D tanker crash on takeoff and get pulled under the ships
screws, after which an individual jumped in the water and
harnessed one of the pilots who surfaced, the wire on a
hovering helicopter broke after it was attached to the
harness, and the pilot fell back into the water and died; (7)
witnessing an individual named "[redacted]" crush his foot in
the gates of an elevator; and (8) being on the vessel when
five men were killed in a fire. At his April 2001 hearing,
the veteran testified that the incidents involving Mr.
[redacted], the pilot who fell back into the water and Mr.
[redacted] most significantly contributed to the development of
his PTSD.
Medical evidence dated after the veteran was discharged from
service satisfies the first element of a PTSD claim under the
former and revised criteria of 38 C.F.R.
§ 3.304, because it shows that the veteran has been diagnosed
with PTSD. Although this evidence also shows that, since
1994, the veteran has been diagnosed with other psychiatric
disorders, these alternative diagnoses do not constitute a
preponderance of the evidence against the veteran's claim
that he has PTSD.
The veteran began expressing complaints of depression in
September 1994, when he visited the Family Medicine Institute
at the Kennebec Valley Medical Center. He indicated that he
was actively participating in an Alcoholics Anonymous
recovery program, but still had mood swings. The examiner
diagnosed "recovering alcoholic with dysthymia." In
November 1994, an examiner at the same facility diagnosed
depression and alcoholism.
In July 1995, the veteran visited the mental health clinic at
the VA Medical Center in Togus, Maine. A psychologist
evaluated the veteran and concluded that he may have had PTSD
for years as part of his developing alcoholism and that it
was likely that he began using alcohol during early adulthood
to relieve painful emotional stimuli associated with PTSD.
The psychologist referred the veteran to a VA psychiatrist,
who definitively diagnosed PTSD. The psychiatrist explained
that the veteran was clearly suffering from PTSD and was
depressed and that it was unclear as to how much of this
depression was due to major depression and did not represent
a reaction to the ongoing untreated PTSD and the veteran's
precarious financial situation. He advised the veteran to
submit an application for service connection for PTSD and
referred him to a PCT/PTSD program for an evaluation. The
veteran failed to report for the scheduled evaluation, but
visited the same psychiatrist in October 1995. On this date,
the psychiatrist did not render a diagnosis. During a
subsequent visit the same month, the veteran was screened for
inpatient and outpatient services. Testing results revealed
that the veteran met the full criteria for a diagnosis of
PTSD. However, in November 1995, a social worker indicated
that, given the veteran's family history of other mental
illnesses, bipolar disorder and depression with psychotic
features should be ruled out.
The veteran was hospitalized in November 1995 for a two-week
stress stabilization program. On discharge, he was diagnosed
with PTSD with depression and panic disorder. Following his
discharge, the veteran began participating in stress
management group therapy and the VA Day Treatment Center
Program. In addition, he continued to see the VA
psychiatrist for medication. From November 1995 to December
1995, no medical professional rendered a diagnosis, but the
veteran was referred to as a "PTSD vet."
In mid-November 1995, while the veteran was participating in
therapy at the VA Medical Center, the veteran presented to
the emergency room of Kennebec Valley Medical Center
complaining of an irregular heart beat. He reported a
history of PTSD. A physician evaluated the veteran and
diagnosed anxiety.
The same month, the veteran underwent a VA examination,
during which an examiner (psychiatrist) diagnosed the veteran
with bipolar disorder and alcohol dependence and indicated
that the veteran did not meet the criteria for PTSD.
In May 1996, the veteran was referred to a VA physician for
back, hand and wrist pain. During this evaluation, the VA
physician noted that the veteran had severe PTSD, "as
recorded in the history."
In August 1996, the veteran underwent another VA examination,
during which the same examiner who evaluated the veteran in
November 1995 diagnosed bipolar disorder and alcohol
dependence, currently in remission. He explained that the
veteran did not fulfill the criteria for PTSD, but that the
veteran's bipolar disorder may well be related to his period
of military service.
The veteran was evaluated by a private psychiatrist, Lawrence
B. Mutty, M.D., in April 1997. Based on the veteran's
thorough report of medical and service histories, a review of
the claims file and a comprehensive evaluation, Dr. Mutty
diagnosed PTSD with a depressive component and alcohol
dependence in recovery phase, by history.
In November 1997, after the veteran questioned the competency
of the VA examiner (psychiatrist) who conducted the November
1995 and August 1996 VA examinations, the RO scheduled the
veteran for another VA examination. During this examination,
the examiner (psychologist) diagnosed depressive disorder,
not otherwise specified, personality disorder, not otherwise
specified, avoidant, schizoid and dependent features.
The veteran subsequently moved out of the state of Maine, and
in November 2000, he was referred to a private psychologist,
Jeffrey M. Merin, Ph.D., for a determination as to whether
the veteran was appropriate for vocational rehabilitation.
Based on the veteran's report of a history of PTSD and
bipolar disorder, and test results, which revealed findings
consistent with a history of PTSD and bipolar disorder and
established the presence of residual symptoms of those
disorders, Dr. Merin diagnosed bipolar disorder, not
otherwise specified, PTSD (per client's report), and pain
disorder associated with both psychological factors and a
general medical condition.
As is shown above, medical professionals have variously
diagnosed the veteran's psychiatric symptoms. However, the
Board believes that there is sufficient evidence of record
establishing a diagnosis of PTSD. The Board acknowledges
that, to date, four private and VA psychologists and
psychiatrists and one private physician have diagnosed the
veteran with disorders other than PTSD. That
notwithstanding, four private and VA psychiatrists and one
orthopedist have also diagnosed the veteran with PTSD, and a
VA psychologist, VA social worker and VA program coordinator
have noted that the disorder is present. Again, inasmuch as
the preponderance of the evidence is not against the
veteran's claim that he has PTSD, the record satisfies the
first element of a PTSD claim under the former and revised
criteria of 38 C.F.R. § 3.304.
The record also satisfies the second element of a PTSD claim
under the former and revised criteria of 38 C.F.R. § 3.304,
because, as explained below, it includes credible supporting
evidence of record that some of the claimed stressors
occurred.
The United States Court of Appeals for Veterans Claims (the
Court) has held that, in adjudicating a claim for PTSD, the
evidence necessary to establish the occurrence of a stressor
during service varies depending on whether the veteran was
"engaged in combat with the enemy." Hayes v. Brown, 5 Vet.
App. 60, 66 (1993). If it is shown through military citation
or other appropriate evidence that a veteran engaged in
combat with the enemy and the claimed stressors are related
to combat, the veteran's lay testimony regarding the reported
stressors must be accepted as conclusive evidence of their
actual occurrence, provided the testimony is found to be
satisfactory, e.g., credible and "consistent with the
circumstances, conditions, or hardships of such service."
In such cases, no further developmental or corroborative
evidence is necessary. 38 U.S.C.A. § 1154(b) (West 1991); 38
C.F.R. § 3.304(d) (2001). In determining whether the veteran
participated in combat, the veteran's oral and written
testimony will be weighed together with the other evidence of
record. Cohen v. Brown, 10 Vet. App. 128, 146 (1997).
In this case, the veteran does not claim, and the record does
not show, that the veteran engaged in combat with the enemy
during his period of active service. Although service
personnel records confirm that the veteran served on the USS
Enterprise, a nuclear powered warship that operated in the
combat zone of Vietnam during the Vietnam era and engaged in
combat operations, there is no evidence that the veteran
participated in such operations to the extent necessary to
constitute engagement in combat.
In a precedent opinion issued by VA's General Counsel it was
held that the ordinary meaning of the phrase "engaged in
combat with the enemy," as used in 38 U.S.C.A. § 1154(b),
requires that a veteran "have participated in events
constituting an actual fight or encounter with a military foe
or hostile unit or instrumentality." VAOPGCPREC 12-99, 65
Fed. Reg. 6256-6258 (2000). The General Counsel also held
that the determination of whether a veteran engaged in combat
with the enemy necessarily must be made on a case-by-case
basis, and that absence from a veteran's service records of
any ordinary indicators of combat service may, in appropriate
cases, support a reasonable inference that the veteran did
not engage in combat; such absence may properly be considered
"negative evidence" even though it does not affirmatively
show that the veteran did not engage in combat. Id.
In this case, the veteran's DD Form 214 reflects no
participation in combat operations. Rather, it shows that
the veteran's primary military occupational specialty was a
yeoman and that he did not receive any commendations or
medals typically awarded primarily or exclusively for
circumstances related to combat, such as the Combat
Infantryman Badge, Purple Heart, or any other similar
citation. Moreover, information on the USS Enterprise from
the Naval Historical Center does not indicate that, during
the veteran's period of active service, servicemen with a
rating of yeoman engaged in combat operations. Based on the
foregoing, the Board finds that the preponderance of the
evidence is against any claim that the veteran participated
in combat. See Cohen, 10 Vet. App. at 145; VAOPGCPREC 12-99.
Where a determination is made that the veteran did not
"engage in combat with the enemy," or that the claimed
stressor is not related to combat, the veteran's lay
testimony alone will not be enough to establish the
occurrence of the alleged stressor. In such cases, the
record must contain service records or other corroborative
evidence that substantiates or verifies the veteran's
testimony or statements as to the occurrence of the claimed
stressor. See West (Carlton) v. Brown, 7 Vet. App. 70, 76
(1994); Zarycki v. Brown, 6 Vet. App. 91, 98 (1993).
In Doran v. Brown, 6 Vet. App. 283, 290-91 (1994), the Court
stated that "the absence of corroboration in the service
records, when there is nothing in the available records that
is inconsistent with other evidence, does not relieve the BVA
of its obligations to assess the credibility and probative
value of the other evidence." Since the VA ADJUDICATION
PROCEDURE MANUAL M21-1 (MANUAL 21-1) was revised to read, in
part, that corroborating evidence of a stressor is not
restricted to service records, but may be obtained from other
sources, the Court has held that the requirement in 38 C.F.R.
§ 3.304(f) for "credible supporting evidence " means that
the "appellant's testimony, by itself, cannot establish the
occurrence of a noncombat stressor." See Moreau v. Brown, 9
Vet. App. 389, 395 (1996); Dizoglio v. Brown, 9 Vet. App.
163, 166 (1996).
In this case, there is no evidence verifying most of the
veteran's stressors, but there is sufficient information in
the claims file to verify substantially three of the verified
stressors. With regard to the veteran's alleged beatings by
an aviation boat chief, there is no documentation of record
confirming that this occurred. In a May 2001 letter, the
veteran's mother indicates that she recalls the veteran
speaking of a chief who slapped and kicked guys in the butt
when they were working slowly, but there is no
contemporaneous evidence to support her statement. In any
event, during VA treatment in 1995, the veteran reported
that, prior to the visit, he had not told anyone about the
beatings. With regard to the veteran's alleged witnessing of
a jet pilot being killed when he backed up into an aircraft's
propellers, [redacted] [redacted] being sliced by a turnbuckle, and
"[redacted]" crushing his foot in the gates of an elevator,
there is no documentation of record confirming that these
events occurred. The veteran has submitted narrative
histories of the USS Enterprise from January 1, 1965 to
December 31, 1966, but these histories do not mention the
alleged incidents. The veteran has also submitted a document
listing the individuals who served on the USS Enterprise and
died during the aforementioned time period, but without
additional information from the veteran, it is impossible to
determine whether any of the listed individuals is the pilot
who allegedly backed up into the propellers.
With regard to the remaining stressors, there is
documentation of record verifying, at least in part, that the
events occurred. With regard to the veteran's alleged
transfer from the Captain's office, where he was serving as a
yeoman striker, to the flight deck, the veteran has submitted
the envelope of a letter sent to his parents from the USS
Enterprise in December 1965 and copies of service medical
records, which show that the veteran was serving in Division
V-1. He has also submitted letters from his mother and
brother, a retired officer in the Army Reserve, confirming
that he was transferred to the flight deck, where he
witnessed injuries and deaths. While the fact that the
veteran served in Division V-1, a flight division, is
insufficient to establish that he served on the flight deck
(he may have served as a clerk for that division), the Board
has no reason to doubt the credibility of the veteran's
mother and his brother, who also served on behalf of his
country. Accordingly, the Board accepts their statements as
evidence that the veteran served on the flight deck of the
USS Enterprise. With regard to the veteran's witnessing of
the death of Mr. [redacted], his flight deck buddy, and the
deaths of an A-3 tanker's crew, the narrative histories of
the USS Enterprise verify that the deaths occurred.
According to these histories, Mr. [redacted] died in the manner
alleged by the veteran, in November 1965, after being blown
off the flight deck by jet exhaust. In addition, in April
1966, a pilot and his crewmen were killed when an A-3B
collapsed on takeoff and careened off the edge of the flight
deck.
There is no documentation of record confirming that, in April
1966, a rescue effort was attempted in the manner alleged by
the veteran or that the veteran was working on the flight
death and witnessed the November 1965 and April 1966
incidents when they occurred. However, the Board believes
that, being part of the crew of the USS Enterprise, such
incidents would constitute stressors regardless of whether
they were actually witnessed. In fact, the recorder of the
narrative histories pointed out this fact when he wrote, in
reference to the April 1966 incident, that the event caused
"sudden shock felt by all the crew."
There is clearly credible supporting evidence of record that
some of the claimed stressors occurred. Therefore, the
record satisfies the second element of a PTSD claim under the
former and revised criteria of 38 C.F.R. § 3.304. The record
also satisfies the third element of a PTSD claim under the
former and revised criteria of 38 C.F.R. § 3.304, because, as
explained below, it contains medical evidence linking the
veteran's current PTSD symptoms to the verified in-service
stressors.
As previously indicated, from July 1995 to November 2000, the
veteran was noted to have, or was diagnosed with, PTSD on
eight occasions. In July 1995, a VA psychologist rendered a
less than definitive diagnosis of PTSD by concluding that the
veteran may have had PTSD for many years. Given that the
opinion is speculative, the Board will not consider it in
determining whether the veteran's PTSD and verified in-
service stressors are linked. The Board also will not
consider the November 1995 and December 1995 notations of the
VA social worker and VA program coordinator, who indicated
that the veteran had PTSD, or the May 1996 opinion of the VA
physician who evaluated the veteran's back, hands and wrist.
The first two individuals are not qualified to diagnose
psychiatric disorders and the third individual based his
diagnosis solely on a history provided by the veteran. The
November 2000 diagnosis is also unhelpful as it was not based
on in-service stressors reported by the veteran.
The remaining three diagnoses support the veteran's claim as
they were based, at least in part, on alleged in-service
stressors that have since been verified. In July 1995, a VA
psychiatrist diagnosed PTSD based partially on the veteran's
report of his experiences on the flight deck, recounted while
weeping. In November 1995, when the veteran was discharged
from a stress stabilization program, a VA psychiatrist
diagnosed PTSD with depression and panic attacks based
partially on the veteran's report of the death of his
shipmate, who fell over the side and whose body was not
recovered. Finally, in April 1997, Dr. Mutty, a private
psychiatrist, diagnosed PTSD with a depressive component
based partially on the veteran's report of Mr. [redacted]'s
death and the crash of the A-3 tanker, which resulted in the
crew's deaths. These diagnoses clearly link the veteran's
PTSD symptoms, in part, to verified in-service stressors.
When, after consideration of all of the evidence of record,
there is an approximate balance of positive and negative
evidence regarding the merits of an issue material to the
determination of the matter, the veteran shall be given the
benefit of the doubt in resolving his claim. 38 U.S.C.A. §
5107(b) (West 1991 & Supp. 2001). In a case in which the
evidence supports the claim, it must be granted. In a case
in which the preponderance of the evidence is against the
claim, it must be denied. In this case, after a thorough
review of the record, the Board does not find that the
evidence fully supports each element of the veteran's claim;
however, it is unable to find that the preponderance of the
evidence is against the veteran's claim. In view of this,
the Board resolves reasonable doubt in the veteran's favor
and concludes that service connection should be granted. The
veteran has submitted medical evidence diagnosing PTSD,
credible supporting evidence substantially verifying that
three of the alleged in-service stressors actually occurred,
and medical evidence linking PTSD to two of the verified in-
service stressors. Accordingly, the veteran is entitled to
service connection for PTSD.
ORDER
Service connection for PTSD is granted.
STEVEN L. COHN
Member, Board of Veterans' Appeals